Organization
LAS CUMBRES COMMUNITY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA J BISSELL MPH (COO)
(857) 523-0654
Entity
Organization
Contact information
Practice address
404 HUNTER ST, ESPANOLA, NM 87532-2655
(505) 753-4123
Mailing address
102 N CORONADO AVE, ESPANOLA, NM 87532-2700
(505) 629-1813
(505) 747-0421
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
E7436
NM
252Y00000X
Early Intervention Provider Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
E7436
—
NM
Enumeration date
04/11/2018
Last updated
07/20/2022
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